| Corporate
& Financial Section
|
|
Annual
Statement General Instructions
|
Application for a
Certificate of Registration - Medical Discount Plans
PDF Format
MS Word Format
|
| FAQ's
- Annual/Quarterly Financial Filings
|
| Form AR-1 - Certificate of Assuming Insurer
|
|
Fraternal
Organization Checklist
|
|
Health
Checklist (HMO's and Limited Health Service Organizations)
|
|
HMO
Calculation of Reserve for Insolvency and Instructions
|
| Holding
Company - General Instructions for Forms A, B, C, D and E
|
| Holding
Company - Form A
|
| Holding
Company - Form B
|
| Holding
Company - Form C
|
| Holding
Company - Form D
|
| Holding
Company - Form E
|
| Insurer
Change
of Address Form (COMPANIES ONLY)
|
|
Life,
Accident and Health Checklist
|
|
Motor
Clubs Checklist
|
|
Premium
Finance Checklist
|
|
Property
& Casualty Checklist
|
| Purchasing
Group - Notice and Registration
|
| Rate
Service Organization Licensing Procedures
|
|
Renewal
Rates
|
| Required
Industry Reports
|
| Surplus
Lines Brokers Annual Statement
|
| Surplus
Lines Brokers Quarterly Statement
|
| Surplus
Lines Company - Eligible Unauthorized Insurers Annual Renewal
Filing Requirements
|
|
Title
Checklist
|
| UCAA
(Uniform Certificate of Authority Application)
|
|
Enforcement
Section
|
|
Insurance
Fraud Reporting Forms and Information (link to the Web site
of the Nevada Office of the Attorney General)
|
|
Life Health & HIPAA
|
1.
Instructions to Complete the L&H Uniform Transmittal
Document
2.
L&H Uniform Transmittal Document--Intelligent pdf
MsWord
3.
Matrix for the L&H Transmittal Document
|
|
HIPAA
Section
|
| All
Individuals from Group
|
| Amendment
to the Plan of Operation
|
| Area
Adjustments
|
| Basic
and Standard Health Benefit Plans
|
|
Individual HIPAA Report
|
| Individual
Reinsured
|
|
Required
Industry Reports
|
|
Small Group Report
|
| Selected
Individuals from Group
|
| Yearly
Filing Requirements
|
|
Life
& Health Section
|
|
Consumer Credit Disclosure Form |
2008 Credit Data Call Instructions
2008 Credit Reporting
Form - Life (Excel)
2008 Credit Reporting
Form - AH (Excel)
2008 Credit Reporting Form - IUI
(Excel) |
| Discretionary
and Non-Employer Groups (LH 100)
|
| Fraternal
Organization Checklist
|
| Insurer
Complaint Reporting Form
|
|
Health
Checklist (HMO's and Limited Health Service Organizations)
|
|
Life,
Accident and Health Checklist
|
|
Required
Industry Reports
|
| Uniform
Credentialing Form
|
| Producer
Licensing Section
|
|
Requests for Written Consent to Engage in the Business of
Insurance Under the Provisions of the Violent Crime Control and
Law Enforcement Act of 1994: 18 U.S.C. Sections 1033 and 1034
The 1994 Federal Act requires anyone convicted of a felony,
involving dishonesty or breach of trust, who is working in the
business of insurance to receive a waiver from his or her state
insurance commissioner to continue to work in the business of
insurance. These two forms are suggested for use by the
Antifraud Task Force for the convenience of the NAIC members.
Not all states accept or will use these two request for waiver
forms. For a copy of the
Short Application Form see form number 344 below, and for
the Standard
Application Form see form number 345 below.
|
|
301 |
Resident
Individual Instructions |
|
302 |
Resident
Business Entity Instructions |
|
303 |
Nonresident Individual
Instructions |
|
304 |
Nonresident
Business Entity Instructions |
|
305 |
Limited
Lines Producer |
|
305A |
Limited
Car Rental |
|
305B |
Requirements
for Short Term Lessor of Motor Vehicles |
|
307 |
Independent
or Public Adjuster |
|
308 |
Motor Vehicle
Damage Appraiser - Individual |
|
308A |
Motor Vehicle
Damage Appraiser - Firm |
|
311 |
Utilization
Review Licensing Application |
|
312 |
Third
Party Administrator Application |
|
312A |
TPA JULY 1 Annual Report Check List |
|
312B |
TPA Monies Received and Distributed Filing Form
|
|
315 |
Notice
of Termination |
|
316 |
Change
of Address |
|
317 |
License
Verification/Letter of Certification |
|
318 |
Appointment Information |
|
319 |
Duplicate
License Renewal |
|
320 |
Exemption
from Continuing Education Regulation |
|
322 |
Additional
Location |
|
323 |
Instructions
to Obtain a Letter of Clearance |
|
323A |
Instructions to
Obtain a Duplicate License |
|
323B |
Voluntary
Surrender of License |
|
324 |
Criminal
History Report Instructions for Residents |
|
325 |
Business
Entity Application
NAIC Business
Entity Application |
|
325A |
Business
Entity Modification Form |
|
326 |
Business
Entity Name Change |
|
326A |
Resident and
Nonresident Business Entity Fictitious/DBA Filing Form |
|
327 |
Individual
Application
NAIC Individual
Application
|
|
327A |
Individual
Resident & Non-Resident Affiliation/Modification Form |
|
327B |
Resident and
Nonresident Individual Fictitious/DBA Filing Form |
|
328 |
Individual
Name Change |
|
329 |
Motor
Vehicle Damage Appraiser Bond |
|
330 |
Bail
Bondsman Bond Form |
|
331 |
Sample
Bond for Managing General Agent |
|
332 |
Sample
Bond for Third Party Administrator |
|
333 |
Bail
Bondsman Bulletin No. 97-002 |
|
334 |
Bail Agent
Licensing Packet |
|
334C |
Bail
Residency Questionnaire |
|
334M8A |
Collateral
Disbursement and Forfeiture Log |
|
334M8C |
Early Surrender of Defendant
|
|
335 |
Bail
Enforcement Agent |
|
336 |
Bail
Agency |
|
337 |
General
Agent for Bail |
|
338 |
Managing
General Agent |
|
339 |
Title
Agency |
|
339A |
Title
Agent/Title Insurer Surety Bond |
|
340 |
Title
Agent/Escrow Officer |
|
340A |
Title Addendum |
|
341 |
Travel
Baggage Corporation |
|
342 |
Viatical
Provider or Viatical Broker Packet |
|
342A |
Requirement
Checklist for Viaticals/Life Settlements License |
|
342B |
Viatical
Settlement Registration Form for Life Producers |
|
343 |
Nevada
Approved Prelicensing Education Sponsors |
|
344 |
Requests
for Written Consent to Engage in the Business of Insurance Under
the Provisions of the Violent Crime Control and Law Enforcement
Act of 1994: 18 U.S.C. Sections 1033 and 1034
Short
Application Form |
|
344A |
Application
for Written Consent 18 U.S.C. Section 1033 & 1034 - Short
Form Checklist |
|
345 |
Requests
for Written Consent to Engage in the Business of Insurance Under
the Provisions of the Violent Crime Control and Law Enforcement
Act of 1994: 18 U.S.C. Sections 1033 and 1034
Standard
Application Form |
|
345A |
Application
for Written Consent 18 U.S.C. Section 1033 & 1034 - Standard
Form Checklist |
|
346 |
County
Clerks Offices |
|
350 |
CE
Approved Self-Study List |
|
351 |
Bail
- Continuing Education |
|
352 |
Applicant Information for the State Insurance Examination |
|
355 |
Probationary
Insurance License Report |
| Property
& Casualty Section |
|
NOTE: Changes to the Uniform Property &
Casualty Product Coding Matrix became effective January 1,
2009. Insurers must use the correct TOI and Sub-TOI when
submitting paper filings by selecting from the drop down list
provided in the intelligent Uniform Property & Casualty
Transmittal Document.
1.
P&C Uniform Transmittal Document (Intelligent pdf)
2.
Uniform Property & Casualty Product Coding Matrix
3.
Instructions to complete the P&C Uniform Transmittal Document
|
| Motor
Clubs Checklist
|
| Premium
Finance Checklist
|
|
Property
& Casualty Checklist |
| Required
Industry Reports
|
|
Service Contract Application |
| Title
Checklist |
| Workers'
Compensation Filing Requirements |
| Workers'
Compensation Rate Filing/Loss Costs Expense Worksheet (intelligent
form) |
